Jan Hook Email & Phone Number

Knowledgeable of all aspects of the operational areas of the business office, including physician credentialling, billing, insurance verification, transaction posting, contractual allowance processing, collection activities related business office processes Address GP daily billing, posting, insurance issues. Providing oversight of these areas for approximately 40 providers/groups. This includes: Soft Collections, Insurance follow-up, QA on accounts and claims, spot audits on account payments/adjustments, claim appeals. Address issues that arise as liaison between providers/insurers and patients. Research and communications on regulatory requirements and procedures (NPI, HIPAA, etc.), complex claims provider issues, national Workers Compensation/Department of Labor guidelines and issue resolution.

Consulted with customers in long-term healthcare on policies and procedures of insurance and Medicare billing. This involved training the staff on coding procedures, documentation requirements and handling customer service related to billing services provided.· Software evaluation and follow-thru on implementation strategies and analysis of impact those strategies will have on workflows and operations· Working closely with the technical support on issues of configuration, installation choices, master file and category list set up, synonyms and preference lists, etc.· Partiticpation in building new data sets and testing new functionality· Current and new workflow documentation and training· Understanding how workflow decisions translate to application configurations · Developing and documenting internal procedures that will be used in conjunction with the business office applications· Achieving in-depth knowledge of the software and serve as a bridge between end users and vendor implementation staff· Participating in regular day-to-day communication with vendor’s installation team and users, reviewing the software, analyzing business operations, and working with the vendor and end users to tailor the system to the organization · Performing in-depth analyses of workflows, data collection, report details, and other technical issues associated with the use of the software · New project initiation and mangement· Working directly with providers, patients and insurance carriers to insure smooth end-to-end processes · Issue analysis and resolutions· Adherence to regulatory requirements

Review of medical claims billings; initial claims and follow-up on filed claims. Researched changes of Medicare policy and alerting other departments if they were affected. Coordinated contact and worked closely with DME and Prosthetics on the phone with various projects most of which pertain to the collection of Medicare Accounts Receivables as well as changes/guidelines that pertained to our business. In some cases I worked directly with HCFA and HIDA offices for assistance. I was also responsible for maintaining our resident database and reviewing medical records for eligibility of products we were billing , collected the Certificates of Medical Necessity from physicians, verified files had the appropriate documentation, maintained A/R ledger which consists of roughly 400 residents, posted payments, filed co-insurances and gathered information from responsible parties to clear up any unpaid balances and take necessary measures to collect the monies due.

I was responsible for starting a new department where the focus would be utilization vs necessity. This department was created to target physicians treating patients injured and on worker’s comp or involved in auto accidents. I reviewed medical records for the diagnosis and treatments performed as well as coordinated PRO reviews by independent physicians in the same specialty. After all records had been explored I entered the information into our system and sent an recommendation report to the insurance company for them to decide on payment continuation.

The duties involved in this position included: taking care of accounts payable and receivable, payroll, payroll taxes, invoicing, interviewing, running financial, some customer support and answering phones.